Association Between Use of Non–Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation - HHM

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Tuesday, 3 October 2017

Association Between Use of Non–Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation


Shang-Hung Chang, MD, PhD ; I-Jun Chou, MD ; Yung-Hsin Yeh, MD; et al
JAMA. 2017;318(13):1250-1259. doi:10.1001/jama.2017.13883

Non–vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk.

The objective of this research was to assess the association between use of NOACs with and without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation.

The researchers employed a retrospective cohort study using data from the Taiwan National Health Insurance database and including 91 330 patients with nonvalvular atrial fibrillation who received at least 1 NOAC prescription of dabigatran, rivaroxaban, or apixaban from January 1, 2012, through December 31, 2016, with final follow-up on December 31, 2016.

Among the 91, 330 patients with nonvalvular atrial fibrillation taking NOACs, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the use of NOACs alone, was associated with increased risk of major bleeding.

At the end of the study, the researchers suggested that Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs.


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